This invention relates to enterprise-wide data structures for relational data bases and their use in constructing enterprise-wide integrated information processing and reporting system. The invention also provides, in a specific embodiment an information storage, processing and reporting system which integrates the sales, underwriting, administration, claims and actuarial functions that support and service the sale and administration of group insurance products.
The traditional approach of developing data bases and processing systems has been to develop an individual single application data base and data processing system for each of the business functions. Such a traditional approach to data base design has been used to date in the group insurance industry.
For example, the sale and support of group insurance products such as group health care insurance, and the administration of the group insurance program involve a large amount of information processing and reporting. The major types of group insurance products are Life; Accidental Death and Dismemberment; Long Term Disability,; Medical; Dental; and Weekly Disability. The volume of data that must be stored and processed includes the specific parameters of each group insurance plan for each policy holder (e.g., employer) in addition to data on different member groups of that policy holder, and individual group members covered by the plan and their eligible benefits. The scope of coverage for each of the individuals covered under a given plan may also vary. Due to the complexity of the products and the large amount of data, the administration of such group insurance programs presently entails the use of many complex data processing and management processes and systems.
In general, the data bases and processing systems currently in use to administer such group insurance plans are actually aggregations of unconnected individual systems each of which has a limited function. The amount of data shared or exchanged among the components of existing systems is minimal. These current systems are usually old and were designed and installed to support and service an earlier generation of insurance products that did not require processing of the amount of information associated with the insurance products offered today. The organization of these existing systems makes it very difficult and expensive to modify and integrate them.
For example, the sales of group insurance policies would be processed on a sales data processing system and the claims from existing policies would be processed separately on a claims data processing system. Each of these different data processing systems would also be developed based on its own data structures which were often not compatible. Due to the different data structures the various systems must be individually interfaced with each other. This has proven to be expensive and inefficient. In addition, since these current systems were developed as discrete systems, they also have redundant support requirements and are fraught with inconsistencies and operational inefficiencies. For these reasons, the current systems are incapable of efficiently supporting, or being modified to support, the new product development, administration and regulatory reporting requirements of the insurance industry today.
Accordingly, it is an object of this invention to provide a fully integrated information storage, processing and reporting system which will function as a single respository for sales, underwriting, actuarial and management information, for an enterprise and as a single source for processing and reporting it. The invention achieves this objective by developing the system based on a single data structure model for a relational data base which is compatible with and accessible to all of the applications programs of the enterprise-wide system. The system will provide automated sales support, e.g., tracking and reporting proposals; integrated underwriting tools; improved administration systems (e.g., billing), issuance of certificates, etc.; elimination of redundant data capture; and integrated actuarial tools. The system will improve operations by providing work management tools such as integrated case tracking and status reporting, and by providing on-line reference material, such as underwriting guidelines and legislative bulletins.